Changing Management of Hematological Malignancies With COVID-19: Statement and Recommendations of the Lebanese Society of Hematology and Blood Transfusion

Abstract

COVID-19 caused by SARS-Cov-2 is a devastating infection in patients with hematological malignancies. In 2018, the Lebanese Society of Hematology and Blood Transfusion (LSHBT) updated the guidelines for the management of hematological malignancies in Lebanon. In 2019, it was followed by a second update. Given the rapidly changing evidence and general situation for COVID-19, the LSHBT established some recommendations and suggestions for the management of the patients with hematological malignancies taking into account the Lebanese condition, economic situation, and the facts that SARS-Cov-2 infection has apparently been devastating. In this article we present recommendations and proposals to reduce or to manage SARS-Cov-2 infection in the patients with myeloid and lymphoid hematological malignancies.

The Challenges of COVID-19 with Obesity-Related Cancers

“…A detailed overview of the sum of specific treatment recommendations in the frame of COVID-19 is beyond the scope of the current review. Testing for SARS-CoV-2 and, occasionally, chest computed tomography, is indicated for patients before the initiation of each therapy cycle, in donors and recipients before HSCT as well as in the presence of COVID-19-suspicious clinical symptoms [172][173][174][175]. A general pattern of treatment initiation or continuation without delay exists for patients who are considered high risk/high priority within or among specific diagnoses.…”

“…A general pattern of treatment initiation or continuation without delay exists for patients who are considered high risk/high priority within or among specific diagnoses. This also includes allogenic HSCT when carried out with curative intent in an urgent indication (e.g., high-risk ALL or AML [173,175]). Autologous SCT may be delayed for no longer than 8 weeks in less urgent clinical settings (e.g., in eligible MM patients [175,176]).…”

“…Autologous SCT may be delayed for no longer than 8 weeks in less urgent clinical settings (e.g., in eligible MM patients [175,176]). Where possible, highly immunosuppressive alternatives (e.g., schemes including bendamustine) should be avoided [173], and where possible, the lowest effective doses of agents, which may induce aplasia (e.g., methotrexate, cytarabine), should be administered [173]. Appropriate schemes that can be administered in outpatient settings may be preferred [173,175].…”

“…Preventive measures of SARS-CoV-2 acquisition should be strictly adhered to [172]. An occurrence of SARS-CoV-2 infection amidst active treatment generally mandates a pause of systemic anticancer therapy and/or delay of allogeneic HSCT until laboratory resolution (negative PCR test) [173,175], although there are isolated reports of continued modified systemic treatment despite SARS-CoV-2 infection, albeit of noncritical severity [177]. As is the case with any deviation from hematologic cancer treatment protocols, this decision should be weighed against the risk of therapy delay on a case-by-case basis [176].…”

Management of Multiple Myeloma in the Middle East: Unmet Needs, Challenges and Perspective

“…Moreover, access to cytogenetic services (i.e. fluorescence in situ hybridization and next-generation sequencing), remains limited across countries in the Middle East [33][34][35]. While it is undeniable that novel drugs significantly improve MM outcomes, physicians in resource-constrained countries, such as Lebanon, continue to struggle to provide even older drugs (e.g.…”